Luke Lorentzen's documentary about a family-operated ambulance service presents an emergency situation of its own regarding the ethical dilemmas of Mexico City's healthcare system.

Ambulances are a symbol of survival. Many critical patients would die without their speedy transport to hospitals and the interim care along the way. In Luke Lorentzen‘s Midnight Family, the words ambulance and survival are also linked in the story of three and a half members of the Ochoa clan. The family’s livelihood depends on the vehicle and the occupation it provides the lot of them, which isn’t exactly all legal. Working in Mexico’s capital, the Ochoas operate a private service in a corrupt industry situated just outside of the country’s universal health care system.

The film reveals their ethically questionable proceedings. In order to make money, the Ochoas, which include patriarch Fernando and his teenage son Juan, would prefer to take patients to a private hospital, which are better and also will pay them for the business if the patients themselves are incapable. Many of their patients, as we see, do not have the insurance or cash to give the Ochoas a dime. The family puts the customers at risk by traveling further than the public hospital, but there the patients could experience slower care due to overcrowding anyway, and the public ambulances are so few that Mexico City’s nearly nine million people are not guaranteed immediate assistance.

Conservative viewers could make an example out of Midnight Family for its depiction of the failings of a public healthcare system and championing of the Ochoas’ free-market drive. However, the cutthroat measures of the family don’t necessarily paint them in the best light, either. As they rush to the call of potentially paying passengers, the Ochoas race their ambulance against others in sequences that are both thrilling and uncomfortable. The men try to compete for the business as safely as possible, shouting into the streets with an intercom system so they don’t run over any bicyclists, but it’s easy to imagine them unintentionally causing an accident on their own. Which would be fortuitous for them, I suppose. Might a less-moral private ambulance driver just make his own business that way?

Midnight Family shows some of the Ochoas’ own slippery ethical choices, starting with the presence of Fernando’s young son Josué along for the ride most of the time. There is almost no exposition outside of what’s discussed among the men, but gradually we learn little things about the lack of proper equipment and training and how the industry is shadily conducted. Lorentzen films them intimately within the small confines of the ambulance but occasionally covers from a distance, as with scenes where the Ochoas must deal with crooked cops extorting for their cut of whatever the family is able to get out of their patients day to day. Of course, these same police officers will tip them off about emergencies.

Nothing here is easily processed, and Lorentzen isn’t always off the hook regarding what he’s a part of, whether he serves the Ochoas as encouragement or serves the patients as a monitor of their care. The filmmaker, who spent three years with the family as a one-man, two-camera operation, clearly tries to be on the up and up himself. During a scene involving an infant patient’s resuscitation, Lorentzen keeps his lens on the Ochoas and the baby’s father, to spare the audience. We’re not shown much in the way of patients’ injuries, in fact — a lot of this is due to the difficulty in obtaining consent in such situations, of course — but that also means we don’t see much in the way of the Ochoas’ job caring for those injuries.

Midnight Family is not as raw in its aesthetic as you’d expect. Lorentzen shot the documentary with expensive cameras that delivered crisp nighttime cinematography with colors that pop, and he often gives us well-composed frames, even during the rush of action and in the tight space of the ambulance. The result is befitting a portrait of the family rather than a journalistic expose of what they do and are a party to. This is another issue film that puts its characters before the subject matter, although it’s not entirely successful as an empathetic portrayal of its subjects. We’re left with as many questions about who they are as we are about their work and its context.

Ultimately, Midnight Family is, like many documentaries, a kind of unfinished experience. The film is the beginning of a discussion, either one to be had amongst viewers themselves or in the continuation of Lorentzen’s shared perspective through interviews and film festival Q&As — the latter possibly including the Ochoas on display and up for scrutiny (the four of them seen in the film appeared at Sundance this week in support of the film’s premiere). But the main questions of the doc might be what we ask ourselves afterward. Maybe not just as to what we would do to survive in such a specific family business but also about what is best and what is right and also inevitable in such a mixed system of social and commercial care.